Serum and CSF Anti-NMDAR Antibody Testing in Psychiatry.

OBJECTIVE: The authors examined and compared the clinical presentation of CSF positive and negative N-methyl-d-aspartate receptor (NMDAR) antibody. METHODS: The investigators performed a retrospective chart review of NMDAR-antibody-positive cases (serum or CSF) involving patients presenting to psychiatric services from 2010 to 2018 in Queensland, Australia. Presentation, progress, investigations, and efficacy of treatment are detailed. RESULTS: There were 24 serum or CSF NMDAR-antibody-positive cases and three equivocal serum results. High rates of prodromal cognitive deficits, catatonia, speech disturbance, and antipsychotic sensitivity were observed in the 16 CSF NMDAR-antibody-positive case patients and two CSF NMDAR-antibody-negative case patients, all evident before neurological deterioration with seizures, movement disorder, and autonomic disturbance occurring in the weeks following admission. The majority of these patients (N=17) were treated successfully with immunomodulatory therapy. The nine remaining patients, who were CSF NMDAR antibody negative or equivocal, did not demonstrate any of these features and improved with psychiatric care alone. CONCLUSIONS: These findings suggest that traditional psychiatric care may be appropriate for patients with isolated psychiatric symptoms who have positive serum NMDAR testing when CSF is negative and there are no key clinical features such as cognitive deficits, catatonia, speech disturbance, and antipsychotic sensitivity. However, if these key features are present, a trial of immunomodulatory treatment should be considered with repeated examination of CSF for neuronal antibodies.

Catatonic syndrome in acute severe encephalitis due to Borrelia burgdorferi infection.

We report a 19-year-old patient who presented with an acute encephalopathy manifested by catatonia. We isolated Borrelia burgdorferi from the CSF and demonstrated intrathecal production of IgG antibodies against B burgdorferi. The patient completely recovered after intravenous ceftriaxone therapy.

Cerebrospinal fluid homovanillic acid and hypokinetic side effects of neuroleptics.

Eleven psychotic patients treated with neuroleptics for 1 month showed a relatively poor response, more side effects, and a no-tolerance pattern with respect to cerebrospinal fluid (CSF) homovanillic acid (HVA). Within this group the severity of neuroleptic catatonia and Parkinsonian side effects was positively associated with an increase in CSF HVA turnover during the treatment period.

Sleep and neuroendocrine disturbances in catatonia. A case report.

Sleep EEG investigations were performed in a 31-year-old catatonic male patient before and after electroconvulsive therapy and 3 months after recovery. The dexamethasone suppression test was also performed longitudinally together with measurements of CSF 5-HIAA, HVA and 24-h urinary MHPG. A normal male control aged 32 was also investigated. Sleep analysis showed reduced REM latency and increased REM activity and density during the catatonic phase before treatment when compared to the age-matched control. REM latency remained shortened after recovery following ECT treatment and 3 months after recovery. Dexamethasone suppression test, abnormal before treatment normalized with clinical improvement during ECT. Urinary MHPG values were low in the catatonic state and did not change after ECT treatment. CSF HVA and 5-HIAA were also low in the pretreatment period and increased during the 3 months follow-up period. There results indicate that some cases of catatonic behavior may be linked to affective disorders.

Cerebrospinal fluid creatine kinase in acutely psychotic patients.

Significantly elevated serum creatine phosphokinase concentrations have been demonstrated in 70% of patients with acute psychosis. Elevations in spinal fluid creatine phosphokinase (CPK) activity have been reported in several neurological diseases, often in association with otherwise normal routine spinal fluid studies. Spinal fluid and serum were obtained simultaneously from 11 patients with acute psychosis, the majority being schizophrenic. Although the serum CPK was elevated in eight of the 11 subjects, spinal fluid glucose, protein, colloidal gold, and CPK were normal in all cases. The theoretical implications of these results are discussed.